Asthma in the inner city--a growing public health concern in the United States

Inner-city asthma: special considerations for management

PURPOSE OF REVIEW

Asthma is prevalent in inner-city populations, exhibiting significant morbidity and mortality. This review focuses on the consequential findings of recent literature, providing insight into onset of asthma, complicating factors, prediction of exacerbations, and novel treatment strategies.

RECENT FINDINGS

Analyses of environmental influence on inner-city children demonstrated novel interactions, implicating potentially protective benefits from early life exposures to pests and pets and isolating detrimental effects of air pollution on asthma morbidity. Through detailed characterization of inner-city asthmatics, predictors of seasonal exacerbations surfaced. Focused, season-specific treatment of inner-city asthmatics with omalizumab identified those most likely to benefit from season-tailored therapy. Comparative studies of urban and rural populations revealed that race and household income, rather than location of residence, impose the greatest risk for increased asthma prevalence and morbidity.

SUMMARY

Challenging previously conceived exposure-disease relationships, recent literature has elucidated new avenues in the complex interplay between immunologically active exposures and their effects on inner-city asthma. These findings, and improved understanding of other relevant exposures, could steer the direction of primary (and secondary) disease prevention research. Moreover, careful identification of asthma characteristics has effectively established predictors of exacerbations, highlighting individuals for which additional therapies are warranted and for whom such treatments are most likely to be effective.

Prevalence and correlates of asthma in the Puerto Rican population: Behavioral Risk Factor Surveillance System, 2000

The 2000 Behavioral Risk Factor Surveillance System (BRFSS) showed that Puerto Rico had the highest self-reported prevalence of asthma. Our objective was to estimate the self-reported prevalence of asthma among different population subgroups and determine its correlates in Puerto Rican adults as reported by the BRFSS. The BRFSS data gathered during 2000 were analyzed. To determine factors associated with self-reported prevalence of asthma, a simple unconditional logistic regression model was employed; then, to estimate adjusted weighted prevalence odds ratios, a multiple unconditional logistic regression model was used. The self-reported weighted prevalence of ever having asthma among Puerto Rican adults was 15.9% (14.8%-16.9%). Asthma prevalence was significantly higher in the following population subgroups: females (18.8%), educational attainment > 12 years (18.4%), having health coverage (16.3%), and obesity (21.0%). Asthma prevalence did not differ among age groups, region of residence, annual income, smoking at least 100 cigarettes in entire life, and physical activity. Almost half (45.6%) of asthmatics reported having children affected with the condition. The prevalence of asthma in any children of the interviewed was 33.2%, 51.3% were receiving treatment, and 30.6% and 24.3% reported having one to three visits to emergency departments and hospital admissions, respectively, resulting from asthma last year. Based on the logistic regression model, the following factors were significantly associated with asthma: sex, high educational attainment, health coverage and obesity. Consistent with previous studies in Puerto Ricans living in the mainland, a higher than expected prevalence of asthma was observed. The possibility of a genetic-environment interaction deserves further investigation.

Exploring lay definitions of asthma and interpersonal barriers to care in a predominantly Puerto Rican, inner-city community

Lay definitions of asthma were elicited through a single open-ended question from a population-based sample of mostly Puerto Rican, inner-city residents in Buffalo, New York. One hundred fifty-five household responses to the question, "What do you think asthma is?" were analyzed qualitatively using the editing approach. Five common codes emerged in order of significance: "symptoms," "disease," "triggers," "threat," and "coping." Overall, expressions of illness reflected a largely symptomatic perception of asthma regardless of asthma status. Perceptions of "disease" increased with higher level of education. Patients' definitions of illness should be considered to help reduce interpersonal barriers to asthma care.

Characteristics of predominantly nonwhite patients with frequent hospitalizations for acute asthma in Chicago

The purpose of this study was to determine the characteristics of predominantly nonwhite patients with recurrent visits to the emergency department (ED) and admissions to an inner-city hospital in Chicago for acute asthma. Over a 21-month period, two groups of age and gender-matched individuals with asthma seen at the University of Illinois at Chicago Medical Center were studied: group I included 26 patients with frequent visits to the ED and no more than one admission for acute asthma/year; and group II included 28 patients with recurrent visits to the ED and two or more admissions for acute asthma/year. We found that 70% of all patients (38/54) were females and 72% (39/54) were African-Americans. The latter predominated in group II (25/28; 89%). There were no significant differences in public aid recipients, baseline FEV1, type of antiasthma medications used, and illicit drug use between the two groups. However, group II reported more asthma onset before the age of 11 years and used higher daily doses of inhaled corticosteroids than group I (p < 0.05). The average duration of hospital stay in group II was significantly longer (3.3 +/- 0.4 days vs. 2.4 +/- 0.3 days, respectively, mean +/- SEM, p < 0.05), and the average cost per hospitalization in group II significantly exceeded that of group I ($5122 +/- $590 vs. $3740 +/- $450, respectively, p < 0.05). We conclude that African-American females are seen more frequently in the ED for acute asthma and admitted to the hospital in Chicago. They develop asthma before the age of 11 years, use higher daily doses of inhaled corticosteroids, and contribute significantly to the high cost of asthma care.